http://www.cureresearch.com/p/pneumonia/basics.

htm

When to Contact a Medical Professional

Call your doctor if you have:

• Worsening respiratory symptoms

• Shortness of breath, shaking chills, or persistent fevers
• Rapid or painful breathing
• A cough that brings up bloody or rust-colored mucus
• Chest pain that worsens when you cough or inhale
• Night sweats or unexplained weight loss
• Signs of pneumonia and weak immune system, as with HIV or
chemotherapy

Infants with pneumonia may not have a cough. Call your doctor if your infant makes
grunting noises or the area below the rib cage is retracting while breathing.

http://www.nlm.nih.gov/medlineplus/ency/imagepages/1103.htm
 How do people "catch pneumonia"?

What are pneumonia symptoms and signs?

Diagnostic tools include X-rays and examination of the sputum. Treatment depends on
the cause of pneumonia; bacterial pneumonia is treated with antibiotics.

Pneumonia is a common illness, occurs in all age groups, and is a leading cause of
death among the elderly and people who are chronically ill. Vaccines to prevent certain
types of pneumonia are available. The prognosis for an individual depends on the type
of pneumonia, the appropriate treatment, any complications, and the person's
underlying health.

Symptoms
Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the
bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of
fluid from pneumonia.
People with infectious pneumonia often have a cough that produces greenish or yellow
sputum and a high fever that may be accompanied by shaking chills. Shortness of
breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either felt or
worse during deep breaths or coughs. People with pneumonia may cough up blood,
experience headaches, or develop sweaty and clammy skin. Other symptoms may
include loss of appetite, fatigue, blueness of the skin, nausea, vomiting, and joint pains
or muscle aches. Less common forms of pneumonia can cause a variety of other
symptoms. For instance, pneumonia caused by Legionella may cause abdominal pain
and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only
weight loss and night sweats. In elderly people the manifestations of pneumonia may
not be typical. Instead, they may develop new or worsening confusion or may
experience unsteadiness leading to falls. Infants with pneumonia may have many of the
symptoms above, but in many cases, they are simply sleepy or have decreased
appetite.

Physical examination
Individuals with symptoms of pneumonia need medical evaluation. Physical
examination by a health care provider may reveal fever or sometimes low body
temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a
low oxygen saturation, which is the amount of oxygen in the blood as indicated by
either pulse oximetry or blood gas analysis. People who are struggling to breathe,
confused, or who have cyanosis (blue-tinged skin) require immediate attention.
Pneumonia as seen on chest x-ray. A: Normal chest x-ray. B: Abnormal chest x-ray
with shadowing from pneumonia in the right lung (left side of image).
Listening to the lungs with a stethoscope (auscultation) can reveal several things. A lack
of normal breath sounds, the presence of crackling sounds (rales), or increased
loudness of whispered speech (whispered pectoriloquy) can identify areas of the lung
that are stiff and full of fluid, called "consolidation." The examiner may also feel the way
the chest expands (palpation) and tap the chest wall (percussion) to further localize
consolidation. The examiner may also palpate for increased vibration of the chest when
speaking (tactile fremitus). [1]

Chest X-rays, sputum cultures and other tests

An important test for detecting pneumonia in unclear situations is a chest x-ray. Chest
x-rays can reveal areas of opacity (seen as white) which represent consolidation.
Pneumonia is not always seen on x-rays, either because the disease is only in its initial
stages, or because it involves a part of the lung not easily seen by x-ray. In some cases,
chest CT (computed tomography) can reveal pneumonia that is not seen on chest x-ray.
X-rays can be misleading, because other problems, like lung scarring and congestive
heart failure, can mimic pneumonia on x-ray. [2] Chest x-rays are also used to evaluate
for complications of pneumonia. (See below.)

If an individual is not getting better with antibiotics, or if the health care provider has
concerns about the diagnosis, a culture of the person's sputum may be requested.
Sputum cultures generally take at least two to three days, so they are mainly used to
confirm that the infection is sensitive to an antibiotic that has already been started. A
blood sample may similarly be cultured to look for infection in the blood (blood culture).
Any bacteria identified are then tested to see which antibiotics will be most effective.

A complete blood count may show a high white blood cell count, indicating the
presence of an infection or inflammation. In some people with immune system
problems, the white blood cell count may appear deceptively normal. Blood tests may
be used to evaluate kidney function (important when prescribing certain antibiotics) or
to look for low blood sodium. Low blood sodium in pneumonia is thought to be due to
extra anti-diuretic hormone produced when the lungs are diseased (SIADH). Specific
blood serology tests for other bacteria (Mycoplasma, Legionella and Chlamydophila)
and a urine test for Legionella antigen are available. Respiratory secretions can also be
tested for the presence of viruses such as influenza, respiratory syncytial virus, and
adenovirus.

Upper panel shows a normal lung under a microscope. The white spaces are alveoli that
contain air. Lower panel shows a lung with pneumonia under a microscope. The alveoli
are filled with inflammation and debris.
The symptoms of infectious pneumonia are caused by the invasion of the lungs by
microorganisms and by the immune system's response to the infection. Although over
one hundred strains of microorganism can cause pneumonia, only a few of them are
responsible for most cases. The most common causes of pneumonia are viruses and
bacteria. Less common causes of infectious pneumonia include fungi and parasites.

Viruses
Viruses must invade cells in order to reproduce. Typically, a virus reaches the lungs
when airborne droplets are inhaled through the mouth and nose. Once in the lungs, the
virus invades the cells lining the airways and alveoli. This invasion often leads to cell
death, either when the virus directly kills the cells, or through a type of cell self-
destruction called apoptosis. When the immune system responds to the viral infection,
even more lung damage occurs. White blood cells, mainly lymphocytes, activate a
variety of chemical cytokines which allow fluid to leak into the alveoli. This combination
of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen
into the bloodstream.

In addition to damaging the lungs, many viruses affect other organs and thus can
disrupt many different body functions. Viruses also can make the body more
susceptible to bacterial infections; for this reason, bacterial pneumonia often
complicates viral pneumonia.

Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory

syncytial virus (RSV), adenovirus, and metapneumovirus. Herpes simplex virus is a rare
cause of pneumonia except in newborns. People with immune system problems are also
at risk for pneumonia caused by cytomegalovirus (CMV).

Bacteria
Bacteria typically enter the lung when airborne droplets are inhaled, but they can also
reach the lung through the bloodstream when there is an infection in another part of
the body. Many bacteria live in parts of the upper respiratory tract, such as the nose,
mouth and sinuses, and can easily be inhaled into the alveoli. Once inside the alveoli,
bacteria may invade the spaces between cells and between alveoli through connecting
pores. This invasion triggers the immune system to send neutrophils, which are a type
of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending
organisms, and they also release cytokines, causing a general activation of the immune
system. This leads to the fever, chills, and fatigue common in bacterial and fungal
pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the
alveoli and interrupt normal oxygen transportation.
The bacterium Streptococcus pneumoniae, a common cause of pneumonia,
photographed through an electron microscope.
Bacteria often travel from an infected lung into the bloodstream, causing serious or
even fatal illness such as septic shock, with low blood pressure and damage to multiple
parts of the body including the brain, kidneys, and heart. Bacteria can also travel to the
area between the lungs and the chest wall (the pleural cavity) causing a complication
called an empyema.

The types of Gram-positive bacteria that cause pneumonia can be found in the nose or
mouth of many healthy people. Streptococcus pneumoniae, often called
"pneumococcus", is the most common bacterial cause of pneumonia in all age groups
except newborn infants. Another important Gram-positive cause of pneumonia is
Staphylococcus aureus. Gram-negative bacteria cause pneumonia less frequently than
gram-positive bacteria. Some of the gram-negative bacteria that cause pneumonia
include Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas
aeruginosa and Moraxella catarrhalis. These bacteria often live in the stomach or
intestines and may enter the lungs if vomit is inhaled. "Atypical" bacteria which cause
pneumonia include Chlamydophila pneumoniae, Mycoplasma pneumoniae, and
Legionella pneumophila.

Fungi
Fungal pneumonia is uncommon, but it may occur in individuals with immune system
problems due to AIDS, immunosuppresive drugs, or other medical problems. The
pathophysiology of pneumonia caused by fungi is similar to that of bacterial
pneumonia. Fungal pneumonia is most often caused by Histoplasma capsulatum,
Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis.
Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is
most common in the southwestern United States.

Parasites
A variety of parasites can affect the lungs. These parasites typically enter the body
through the skin or by being swallowed. Once inside the body, they travel to the lungs,
usually through the blood. There, as in other types of pneumonia, a combination of
cellular destruction and immune response causes disruption of oxygen transportation.
One type of white blood cell, the eosinophil, responds vigorously to parasite infection.
Eosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the
underlying parasitic pneumonia. The most common parasites causing pneumonia are
Toxoplasma gondii, Strongyloides stercoralis, and Ascariasis.

The resulting lung inflammation is not an infection but can contribute to one,

since the material aspirated may contain anaerobic bacteria or other unusual
causes of pneumonia. Aspiration is a leading cause of death among hospital and

nursing home patients, since they often cannot adequately protect their airways

and may have otherwise impaired defenses.

Treatment
Antibiotics are used to treat bacterial pneumonia. In
contrast, antibiotics are not useful for viral pneumonia,
although they sometimes are used to treat or prevent
bacterial infections that can occur in lungs damaged by
a viral pneumonia. The antibiotic choice depends on the
nature of the pneumonia, the most common
microorganisms causing pneumonia in the local
geographic area, and the immune status and underlying
health of the individual. Treatment for pneumonia
should ideally be based on the causative microorganism
and its known antibiotic sensitivity. However, a specific
cause for pneumonia is identified in only 50% of people,
even after extensive evaluation. Because treatment
should generally not be delayed in any person with a
serious pneumonia, empiric treatment is usually started
well before laboratory reports are available. In the
United Kingdom, amoxicillin is the antibiotic selected for
most patients with community-acquired pneumonia,
sometimes with added clarithromycin; patients allergic
to penicillins are given erythromycin instead of
amoxicillin. In North America, where the "atypical"
forms of community-acquired pneumonia are becoming
more common, azithromycin, clarithromycin, and the
fluoroquinolones have displaced amoxicillin as first-line
treatment. The duration of treatment has traditionally
been seven to ten days, but there is increasing
evidence that shorter courses (as short as three days)
are sufficient.[4][5][6]

Antibiotics for hospital-acquired pneumonia include

vancomycin, third- and fourth-generation
cephalosporins, carbapenems, fluoroquinolones, and
aminoglycosides. These antibiotics are usually given
intravenously. Multiple antibiotics may be administered
in combination in an attempt to treat all of the possible
causative microorganisms. Antibiotic choices vary from
hospital to hospital because of regional differences in
the most likely microorganisms, and because of
differences in the microorganisms' abilities to resist
various antibiotic treatments.

People who have difficulty breathing due to pneumonia

may require extra oxygen. Extremely sick individuals
may require intensive care treatment, often including
intubation and artificial ventilation.

Viral pneumonia caused by influenza A may be treated

with rimantadine or amantadine, while viral pneumonia
caused by influenza A or B may be treated with
 oseltamivir or zanamivir. These treatments are
beneficial only if they are started within 48 hours of the
onset of symptoms. Many strains of H5N1 influenza A,
also known as avian influenza or "bird flu," have shown
resistance to rimantadine and amantadine. There are no
known effective treatments for viral pneumonias caused
by the SARS coronavirus, adenovirus, hantavirus, or
parainfluenza virus.

Vaccines are available for the prevention of specific types of pneumonia. This is usually
given to persons not less than 65 years old and children. Ask your doctor about it.